Thank you for your interest in SpiritRx. Please fill out the form below with your company or client details. We will review your information and contact you shortly with the best options to suit your needs.

This is the date that you wish your policy coverage to start.
e.g. Human Resources, CFO, Director of Compensation etc
Please enter your email, so we can follow up with you.
Enter "n/a" if group number is not applicable.
Enter “80” if the plan is 80%/20% for the majority of the plan members.
Enter “80” if the plan is 80%/20% for the majority of the plan members.
Dollars / Cents
Plan members always pay per presciption.
Please provide information such as: classes, divisions, tiered formulary and any other unique plan parameters. Unique coverage that only applies to the preferred provider.